title: Impact of an international nosocomial infection control consortium multidimensional approach on central line-associated bloodstream infection rates in adult intensive care units in eight cities in India.
abstract: OBJECTIVE
  To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach on central line-associated bloodstream infection (CLABSI) rates in eight cities of India.
  
  
  METHODS
  This was a prospective, before-and-after cohort study of 35650 patients hospitalized in 16 adult intensive care units of 11 hospitals. During the baseline period, outcome surveillance of CLABSI was performed, applying the definitions of the CDC/NHSN (US Centers for Disease Control and Prevention/National Healthcare Safety Network). During the intervention, the INICC approach was implemented, which included a bundle of interventions, education, outcome surveillance, process surveillance, feedback on CLABSI rates and consequences, and performance feedback. Random effects Poisson regression was used for clustering of CLABSI rates across time periods.
  
  
  RESULTS
  During the baseline period, 9472 central line (CL)-days and 61 CLABSIs were recorded; during the intervention period, 80898 CL-days and 404 CLABSIs were recorded. The baseline rate was 6.4 CLABSIs per 1000 CL-days, which was reduced to 3.9 CLABSIs per 1000 CL-days in the second year and maintained for 36 months of follow-up, accounting for a 53% CLABSI rate reduction (incidence rate ratio 0.47, 95% confidence interval 0.31-0.70; p=0.0001).
  
  
  CONCLUSIONS
  Implementing the six components of the INICC approach simultaneously was associated with a significant reduction in the CLABSI rate in India, which remained stable during 36 months of follow-up.
authors.affiliation: Artemis Health Institute, New Delhi, India.
authors.forename: Namita
authors.initials: N
authors.lastname: Jaggi
authors.forename: Camilla
authors.initials: C
authors.lastname: Rodrigues
authors.forename: Victor Daniel
authors.initials: VD
authors.lastname: Rosenthal
authors.forename: Subhash Kumar
authors.initials: SK
authors.lastname: Todi
authors.forename: Sweta
authors.initials: S
authors.lastname: Shah
authors.forename: Narinder
authors.initials: N
authors.lastname: Saini
authors.forename: Arpita
authors.initials: A
authors.lastname: Dwivedy
authors.forename: F E
authors.initials: FE
authors.lastname: Udwadia
authors.forename: Preeti
authors.initials: P
authors.lastname: Mehta
authors.forename: Murali
authors.initials: M
authors.lastname: Chakravarthy
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Singh
authors.forename: Samir
authors.initials: S
authors.lastname: Sahu
authors.forename: Deepak
authors.initials: D
authors.lastname: Govil
authors.forename: Ashit
authors.initials: A
authors.lastname: Hegd
authors.forename: Farahad
authors.initials: F
authors.lastname: Kapadia
authors.forename: Arpita
authors.initials: A
authors.lastname: Bhakta
authors.forename: Mahuya
authors.initials: M
authors.lastname: Bhattacharyya
authors.forename: Tanu
authors.initials: T
authors.lastname: Singhal
authors.forename: Reshma
authors.initials: R
authors.lastname: Naik
authors.forename: Vatsal
authors.initials: V
authors.lastname: Kothari
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.forename: Suvin
authors.initials: S
authors.lastname: Shetty
authors.forename: Sheena
authors.initials: S
authors.lastname: Binu
authors.forename: Preethi
authors.initials: P
authors.lastname: Pinto
authors.forename: Aruna
authors.initials: A
authors.lastname: Poojary
authors.forename: Geeta
authors.initials: G
authors.lastname: Koppikar
authors.forename: Lata
authors.initials: L
authors.lastname: Bhandarkar
authors.forename: Shital
authors.initials: S
authors.lastname: Jadhav
authors.forename: Neeraj
authors.initials: N
authors.lastname: Chavan
authors.forename: Shweta
authors.initials: S
authors.lastname: Bahirune
authors.forename: Shilpa
authors.initials: S
authors.lastname: Durgad
authors.forename: Gita
authors.initials: G
authors.lastname: Nataraj
authors.forename: Pallavi
authors.initials: P
authors.lastname: Surase
authors.forename: B N
authors.initials: BN
authors.lastname: Gokul
authors.forename: R
authors.initials: R
authors.lastname: Sukanya
authors.forename: Leema
authors.initials: L
authors.lastname: Pushparaj
authors.forename: Kavitha
authors.initials: K
authors.lastname: Radhakrishnan
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011446:Prospective Studies; D012307:Risk Factors
keywords: Bundle; Catheter-related infections; Developing countries; Hand hygiene; International Nosocomial Infection Control Consortium; Multidimensional approach